Contextual Overview

A. Information Requirements

1. Information on care provided by NHS hospitals and Primary Care Trusts for all patients, and Independent Sector providers (for NHS patients only) is required to:

   
   
   • monitor and manage Service Agreements;
     
   • develop commissioning plans;
     
   • monitor Health Improvement Programmes;
     
   • underpin clinical governance;
     
   • understand the health needs of the population.

   Main commissioners need access to data to monitor OUT OF AREA TREATMENT activity as part of the management of their Service Agreements. PRIMARY CARE TRUSTS also need to monitor in-year referrals to investigate the sources and reasons for Out of Area Treatments.

   Independent Sector Treatment Centres (TC) are responsible for providing Admitted Patient Care and Out-Patient Attendance CDS and may submit it on their own behalf or via a third party. Other Independent Sector activity for NHS patients is the responsibility of the NHS commissioning body for the provision of the appropriate central returns and datasets.

2. The Department of Health (DH) needs a complete record of all patients admitted to or treated as out-patients by NHS hospitals and Primary Care Trusts including patients receiving private treatment. The record also includes NHS patients treated electively in the independent sector and overseas. Hospital Episode Statistics (HES) are derived from the Admitted Patient Care CDS Types, Out-Patient Attendance and Accident and Emergency Attendance CDS Types submitted via the NHS-wide Clearing Service (NWCS). These records provide information about hospital and patient management and epidemiological data on patient diagnoses and operative procedures. The HES data warehouse has already been used to support many aspects of the new Performance Framework.

B. Data Flows

3. HES records are extracted from the NWCS database quarterly. The timely provision of Admitted Patient Care (APC) records to the NWCS, complete with clinical information, is now a performance issue for Trusts.

4. The strategic direction set out within Information for Health is to develop comprehensive and consistent electronic health records for patients from clinical information flows. In the short term, access to and the analysis of CDS Types will remain important, and the exchange of these data sets should continue on at least a monthly basis.

5. To determine who receives CDS Types, NHS Trusts and Primary Care Trusts need to take all of the following factors into account, not necessarily in the order specified here:

   
   
   • identifying the patient's registered GP - to establish the responsible Primary Care Trust;
   
   
   • determining where the patient is resident - necessary when the patient is not registered with a GP;
   
   
   • assigning the correct type of NHS SERVICE AGREEMENT for the treatment provided;
   
   
   • identifying an overseas visitor and whether the patient is a private patient.
   
   The information data flows are shown in the Tables below.

C. CDS Data Flow Definitions

6. The exchange of individual CDS Types may be mandatory or optional. All Admitted Patient Care and Out-Patient Attendance CDS Type exchanges are mandatory, but exchanges of individual CDS Types for accident and emergency attendances are not, and require local agreement between the parties concerned. Where CDS information is collected, it should always be exchanged via the NHS Wide Clearing Service.

7. Where CDS Types are exchanged, the data items within the CDS Type have a mandatory or optional status. A data item marked as mandatory (M) means that it must be included in the CDS Type; a data item marked as optional (O) means that the data item need only be included if both parties agree to its exchange. Although the exchange of the Accident and Emergency CDS Type may be optional, this does not apply to the status of the data items within this CDS Type.

8. For records relating to CDS activity from the 1st April 2002 see REVISED CDS INFORMATION FLOW ADDRESSING GRID - Activity from 1st April 2002 below.

9. For records relating to CDS activity up to 31st March 2002, see PREVIOUS CDS INFORMATION FLOW ADDRESSING GRID - Activity up to 31st March 2002 below.

REVISED CDS INFORMATION FLOW ADDRESSING GRID - Activity from 1st April 2002

	CDS PRIME RECIPIENT
Patient/Service Agreement	PCT OF RESIDENCE	PCT responsible	Main Commissioner	Organisation to which costs of treatment accrue
Patient registered with GP with PCT Service Agreement	*	*
Patient not registered with a GP but resident in an area covered by a PCT with a PCT Service Agreement	*	*
Patient registered with a GP treated as an Out Of Area Treatment (OAT)	*	*	*
Patient not registered with a GP treated as an Out Of Area Treatment (OAT)	*	*	*
Overseas visitor exempt from charges and not registered with a GP	* (TDH00)		*
Overseas visitor exempt from charges and registered with a GP	* (TDH00)	*	*
Overseas visitor liable for NHS charges and not registered with a GP	* (VPP00)
Overseas visitor liable for NHS charges and registered with a GP	* (VPP00)	*
Patient registered with GP with a Specialised Services & Other Commissioning Consortia Service Agreement	*	*		*
Patient not registered with GP with a Specialised Services & Other Commissioning Consortia Service Agreement	*	*		*
Private Patient	*	*

Notes:

a. Some flows will be sent for unfinished episodes. For example, a consultant episode may be in progress when a data flow is sent. In such cases the end date is not known and the patient has not been discharged. These data items will therefore not be included in that data flow.

b. Note that if two recipients are identical (PCT of Residence is the same as the Main Commissioner) only one data set should be sent to that recipient.

c. For further information please refer to DSCN 46/2002.

PREVIOUS CDS INFORMATION FLOW ADDRESSING GRID - Activity up to 31st March 2002

10. All records relating to CDS activity up to 31st March 2002, including unfinished episodes on that date, will use the previous data flow addressing grid irrespective of when the records are actually sent to the NWCS. For example, an admitted patient episode which ended in March 2002 should be addressed to the appropriate HA or PCG/PCT in existence in March 2002 even though the record may not be sent until 1st April 2002 or later.

Patient/Service Agreement	PCG/PCT	HA responsible for PCG: HA to which PCT is accountable	PCG OR PCT OF RESIDENCE	HA responsible for PCG OR PCT OF RESIDENCE;	Main Comm-issioner	Organisa-tion to which costs of treatment accrue	HA of Residence	Agency acting on behalf of DH
Patient registered with GP with PCG/PCT Service Agreement	*	*					*
Patient not registered with GP but resident in area covered by PCG/PCT with PCG/PCT Service Agreement			*	*			*
Patient registered with GP treated as Out of Area Treatment	*	*			*		*
Patient not registered with GP treated as Out of Area Treatment			*	*	*		*
Overseas visitor exempt from charges					*			* (TDH00)
Overseas visitor - liable for NHS charges								* (VPP00)
Patient registered with GP with Specialised Services & Other Commissioning Consortia Service Agreement	*	*				*	*
Patient not registered with GP with Specialised Services & Other Commissioning Consortia Service Agreement			*	*		*	*
Private Patient	*	*					*

Notes:

a. Some flows will be sent for unfinished episodes. For example, a consultant episode may be in progress when a data flow is sent. In such cases the end date is not known and the patient has not been discharged. These data items will therefore not be included in that data flow.

b. Note that if two recipients are identical (e.g. the HA of Residence is the same as the HA responsible for the patient's PCG) only one data set should be sent to that recipient.